Assessment of nonadherence to inhalation therapy in asthma and chronic obstructive pulmonary disease in Bulgaria

Abstract

Introduction: Treatment for asthma and chronic obstructive pulmonary disease (COPD) is compromised, quality of life is negatively impacted, and significant financial losses result from nonadherence to the prescribed therapy. Aim: To assess the nonadherence to inhaled therapy in patients with asthma and COPD in Bulgaria. Materials and methods: A survey was conducted in 4020 asthma or COPD patients. Demographic data was collected, and a questionnaire was completed for assessing the adherence to inhalation therapy (using the Test of Adherence to Inhalers®, TAI). Results: We found some level of nonadherence to the therapy in 77.2% of the patients. Factors such as sex, education, and smoking did not influence the adherence. There were regional differences in the diagnoses of asthma and COPD concerning intentional or unintentional nonadherence. Erratic and intentional nonadherence occurred more frequently with longer disease duration. When pMDIs were used as opposed to DPI devices, unintentional nonadherence to treatment was more frequent. Using pMDI instead of DPI was associated with a higher likelihood of observing erratic or intentional nonadherence in some regions of the country. There was a positive link between erratic nonadherence to therapy and an intentional or unintentional nonadherences to it. Conclusions: The rate of nonadherence to inhalation therapy for asthma and COPD in Bulgaria is very high and vary for the different regions. The TAI questionnaire allows a quick assessment and definition of the basic types of nonadherence. Correcting the causes of non-adherence to therapy reduces the frequency of exacerbations, improves quality of life, and prolongs the life expectancy of patients with asthma or COPD.